| Doctor Name: | MRS. KRISTIE LYNN JACKSON |
| NPI Number: | 1053407817 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 0024167104 |
| Business Practice Address: | 3700 South Main Street Blacksburg, VA - 24060 |
| Business Phone Number: | 5409535385 |
| Business Fax Number: | |
| Mailing Address: | 2900 Mudpike Road, CHRISTIANSBURG |
| State: | VA |
| Postal Code: | 24073 |
| Phone Number: | 5403829139 |
| Fax Number: | |
| NPI Enumeration Date: | 10/05/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 0024167104 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |